Chimeric antigen receptors containing a chlorotoxin domain

ABSTRACT

Chimeric transmembrane immunoreceptors (CAR) which include an extracellular domain that includes chlorotoxin or a related toxin, or a variant of chlorotoxin or a related toxin, that binds to human glioma or other human tumor cells, a transmembrane region, a costimulatory domain and an intracellular signaling domain are described.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. application Ser. No. 15/767,960, filed on Apr. 12, 2018, which is a National Stage Application under 35 U.S.C. § 371 and claims the benefit of International Application No. PCT/US2016/056901, filed Oct. 13, 2016, which claims the benefit of U.S. Provisional Application No. 62/241,021, filed Oct. 13, 2015. The disclosure of the foregoing applications are hereby incorporated by reference in their entirety.

SEQUENCE LISTING

The present application contains a Sequence Listing, which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Nov. 3, 2021, is named SequenceListing.txt and is 115,000 bytes in size, the entire contents of which are hereby incorporated by reference.

BACKGROUND

Tumor-specific T cell based immunotherapies, including therapies employing engineered T cells, have been investigated for anti-tumor treatment. Chimeric antigen receptors (CARs) are composed of an extracellular tumor recognition/targeting domain, an extracellular linker/spacer, a transmembrane domain, and intracellular T cell-activating and co-stimulatory signaling domains. The design of the reconition/targeting domain is critical to avoiding deleterious off-target effects. The majority of CAR tumor targeting domains are single chain variable fragments (scFvs) derived from antibody sequences that exploit the specificity of antibody binding to particular antigens. There are also examples of CAR tumor targeting domains derived from normal receptor ligands, such as the IL-13 cytokine CAR that targets cells expressing the IL-13 receptor, IL13Rα2. Despite some notable successes, the identification and validation of novel CAR tumor targeting domains remains a major challenge in the field.

Malignant gliomas (MG), which include anaplastic astrocytoma (AA-WHO grade III) and glioblastoma (GBM-WHO grade IV), have an incidence rate of approximately 20,000 new cases diagnosed annually in the United States. According to the American Brain Tumor Association total prevalence of individuals living with a malignant brain tumor, based on United States 2010 census data, is roughly 140,000 persons. Although MG is a rare disease, it is highly aggressive and heterogeneous with respect to its malignant behavior and nearly uniformly lethal. Current standard-of-care therapies for high-grade MG yield only short term benefits, and these brain tumors are virtually incurable. Indeed, even with modern surgical and radiotherapeutic techniques, which often exacerbate the already severe morbidities imposed by location in the central nervous system (CNS), the 5-year survival rates are quite low. Furthermore, for the majority of patients who relapse with disease, there are few therapeutic options. Thus, there is a significant need for more effective therapies, particularly for those patients that have recurred/progressed following frontline therapies.

Adoptive T cell therapy (ACT) utilizing engineered T cells expressing a CAR may provide a safe and effective way to reduce recurrence rates of MG, since CAR T cells can be engineered to specifically recognize antigenically-distinct tumor populations (Cartellieri et al. 2010 J Biomed Biotechnol 2010:956304; Ahmed et al. 2010 Clin Cancer Res 16:474; Sampson et al. 2014 Clin Cancer Res 20:972; Brown et al. 2013 Clin Cancer Res 2012 18:2199; Chow et al. 2013 Mol Ther 21:629), and T cells can migrate through the brain parenchyma to target and kill infiltrative malignant cells (Hong et al. 2010 Clin Cancer Res 16:4892; Brown et al. 2007 J Immunol 179:3332; Hong et al. 2010 Clin Cancer Res 16:4892; Yaghoubi 2009 Nat Clin Pract Oncol 6:53).

SUMMARY

Described herein are chimeric transmembrane immunoreceptors (chimeric antigen receptors or “CARs”) which comprise an extracellular domain, a transmembrane region and an intracellular signaling domain. The extracellular domain includes chlorotoxin (a 36 amino acid peptide toxin found in venom from the scorpion Leiurus quinquestriatus), or a related toxin, or a variant of chlorotoxin or a related toxin, and, optionally, a spacer, comprising, for example, a portion of human Fc domain. The transmembrane portion includes, for example, a CD4 transmembrane domain, a CD8 transmembrane domain, a CD28 transmembrane domain, or a CD3 transmembrane domain. The intracellular signaling domain includes the signaling domain from the zeta chain of the human CD3 complex (CD3) and one or more costimulatory domains, for example, a 4-1BB costimulatory domain. The extracellular domain enables the CAR, when expressed on the surface of a T cell, to direct T cell activity to those cells expressing a receptor for chlorotoxin. Such cells include glioblastoma cells. The inclusion of a costimulatory domain, such as the 4-1BB (CD137) costimulatory domain in series with CD3ζ in the intracellular region enables the T cell to receive co-stimulatory signals. T cells, for example, patient-specific, autologous T cells can be engineered to express the CARs described herein, and the engineered cells can be expanded and used in ACT. Various T cell subsets, including both alpha beta T cells and gamma delta T cells, can be used. In addition, the CAR can be expressed in other immune cells such as NK cells. Where a patient is treated with an immune cell expressing a CAR described herein the cell can be an autologous T cell or an allogenic T cell. In some cases, the cells used are a cell population that includes both CD4+ and CD8+ central memory T cells (T_(CM)), which are CD62L+, CCR7+, CD45RO+, and CD45RA−, or the cells used are a cell population that includes CD4+ and CD8+T_(CM) cells, stem central memory T cells and naïve T cells (i.e., a population of T_(CM/SCM/N) cells). A population of T_(CM/SCM/N) cells are CD62L+, CCR7+ and include both CD45RA+ and CD45RO+ cells as well as both CD4+ cells and CD8+ cells. The use of such cells can improve long-term persistence of the cells after adoptive transfer compared to the use of other types of patient-specific T cells.

Described herein is a nucleic acid molecule encoding a CAR comprising: chlorotoxin (MCMPCFTTDHQMAKRCDDCCGGKGRGKCYGPQCLCR; SEQ ID NO:1) or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) provided that the cysteine residues are not modified; a transmembrane domain selected from: a CD4 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD8 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD28 transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), and a CD3ζ transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); a costimulatory domain (e.g., a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or both a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); and a CD3ζ signaling domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications.

In some embodiments the CAR includes a toxin related to chlorotoxin instead of chlorotoxin. Thus, the CAR can include GaTx2, a toxin from Leiurus quinquestriatus hebraeus (VSCEDCPDHCSTQKARAKCDNDKCVCEPI; SEQ ID NO:56) or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) provided that the cysteine residues are not modified; a transmembrane domain selected from: a CD4 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD8 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD28 transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), and a CD3ζ transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); a costimulatory domain (e.g., a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or both a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); and CD3 ζ signaling domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions).

In some cases, the CAR can include more than one chlorotoxin sequence (e.g., two or three or more copies of SEQ ID NO:1 either consecutively or separated by 1-10 amino acids) or more than one toxins related to chlorotoxin. Thus, the CAR can include two or chlorotoxin sequences (e.g., SEQ ID NO:1 followed by SEQ ID NO:1 followed by the rest of the molecule) or the CAR can include a chlorotoxin sequence followed by the sequence of a toxin related to chlorotoxin (e.g., SEQ ID NO:57 or another toxin depicted in FIG. 25.

The CAR can include GaTx1, a toxin from Leiurus quinquestriatus hebraeus (CGPCFTTDHQMEQKCAECCGGIGKCYGPQCLCNR; SEQ ID NO:57) or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) provided that the cysteine residues are not modified; a transmembrane domain selected from: a CD4 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD8 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD28 transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), and a CD3ζ transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications; a costimulatory domain (e.g., a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or both a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); and CD3ζ signaling domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions).

The CAR can include AaCtx, a toxin from Androctonus australis (MCIPCFTTNPNMAAKCNACCGSRRGSCRGPQCIC; SEQ ID NO:58) or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) provided that the cysteine residues are not modified; a transmembrane domain selected from: a CD4 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD8 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD28 transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), and a CD3ζ transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications; a costimulatory domain (e.g., a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or both a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); and CD3 ζ signaling domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions).

The CAR can include BmKCT, a toxin from Buthus martensii (CGPCFTTDANMARKCRECCGGIGKCFGPQCLCNRI; SEQ ID NO:59) or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) provided that the cysteine residues are not modified; a transmembrane domain selected from: a transmembrane domain depicted in Table 2 or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications a CD4 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD8 transmembrane domain or variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD28 transmembrane domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions), and a CD3ζ transmembrane domain or a variant thereof having 1-10 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); a costimulatory domain (e.g., a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or both a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); and CD3 ζ signaling domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions).

In various embodiments, the CAR comprises the amino acid sequence of any of SEQ ID NOs:26-55 wherein the chlorotoxin sequence (SEQ ID NO:1) is replaced by an amino acid sequence selected from SEQ ID NOs: 56-59 or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions)

In various embodiments: the costimulatory domain is selected from the group consisting of: a costimulatory domain depicted in Table 3 or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications, a CD28 costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications, a 4-1BB costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications and an OX40 costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications. In certain embodiments, a 4-1BB costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications in present. In some embodiments there are two costimulatory domains, for example a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions). In various embodiments the 1-5 (e.g., 1 or 2) amino acid modification are substitutions.

In some cases, there is a short sequence of 1-6 amino acids (e.g. GGG) between the co-stimulatory domains and the CD3 ζ signaling domain and/or between the two co-stimulatory domains.

Additional embodiment the CAR comprises: a variant of a chlorotoxin having 1-5 amino acid modifications that increase binding specificity or immunogenicity for the chlorotoxin receptor (Cltx-R); the chlorotoxin variant is a variant comprising the amino acid sequence of SEQ ID NO:1 with 1-5 (e.g., 1 or 2) amino acid modifications; two different costimulatory domains selected from the group consisting of: a CD28 costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications, a 4-1BB costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications and an OX40 costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications; two different costimulatory domains selected from the group consisting of: a CD28 costimulatory domain or a variant thereof having 1-2 amino acid modifications, a 4-1BB costimulatory domain or a variant thereof having 1-2 amino acid modifications and an OX40 costimulatory domain or a variant thereof having 1-2 amino acid modifications; chlorotoxin or a variant thereof having 1-2 amino acid modifications; a transmembrane domain selected from: a CD4 transmembrane domain or variant thereof having 1-2 amino acid modifications, a CD8 transmembrane domain or variant thereof having 1-2 amino acid modifications, a CD28 transmembrane domain or a variant thereof having 1-2 amino acid modifications, and a CD3ζ transmembrane domain or a variant thereof having 1-2 amino acid modifications; a costimulatory domain (e.g., a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or both a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); and CD3ζ signaling domain of a variant thereof having 1-2 amino acid modifications; a spacer region located between the chlorotoxin or variant thereof and the transmembrane domain (e.g., the spacer region comprises an amino acid sequence selected from the group consisting of SEQ ID NOs: 2-12 (Table 3) or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications); the spacer comprises an IgG hinge region; the spacer region comprises 1-150 amino acids; there is no spacer; the 4-1BB signaling domain comprises the amino acid sequence of SEQ ID NO:24 the CD3ζ signaling domain comprises the amino acid sequence of SEQ ID NO:21 and a linker of 3 to 15 amino acids that is located between the costimulatory domain and the CD3ζ signaling domain or variant thereof. In certain embodiments where there are two costimulatory domains, one is a 4-1BB costimulatory domain and the other a costimulatory domain selected from: CD28 and CD28gg. In various embodiments the 1-5 (e.g., 1 or 2) amino acid modification are substitutions.

In some embodiments: nucleic acid molecule expresses a polypeptide comprising an amino acid sequence selected from SEQ ID NOs: 26-55; the chimeric antigen receptor comprises an amino acid sequence selected from SEQ ID NOs: 26-55.

Also disclosed is a population of human T cells transduced by a vector comprising an expression cassette encoding a chimeric antigen receptor, wherein chimeric antigen receptor comprises: either chlorotoxin or a variant thereof having 1-5 amino acid modifications (e.g., 1 or 2) amino acid modifications (e.g., substitutions) or a toxin related to chlorotoxin or a variant thereof having 1-5 amino acid modifications (e.g., 1 or 2) amino acid modifications (e.g., substitutions); a transmembrane domain selected from: a CD4 transmembrane domain or variant thereof having 1-5 amino acid modifications (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD8 transmembrane domain or variant thereof having 1-5 amino acid modifications (e.g., 1 or 2) amino acid modifications (e.g., substitutions), a CD28 transmembrane domain or a variant thereof having 1-5 amino acid modifications (e.g., 1 or 2) amino acid modifications (e.g., substitutions), and a CD3ζ transmembrane domain or a variant thereof having 1-5 amino acid modifications (e.g., 1 or 2) amino acid modifications (e.g., substitutions); a costimulatory domain (e.g., a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or both a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); and CD3 ζ signaling domain of a variant thereof having 1-5 amino acid modifications (e.g., 1 or 2) amino acid modifications (e.g., substitutions). In various embodiments: the population of human T cells comprise a vector expressing a chimeric antigen receptor comprising an amino acid sequence selected from SEQ ID NOs: 26-55 or a variant thereof having 1-5 amino acid modifications (e.g., 1 or 2) amino acid modifications (e.g., substitutions); the population of human T cells comprises central memory T cells (T_(CM) cells) e.g., at least 20%, 30%, 40%, 50% 60%, 70%, 80% of the cells are T cm cells, or the population of T cells comprises a combination of central memory T cells, naïve T cells and stem central memory cells (T_(CM/SCM/N) cells) e.g., at least 20%, 30%, 40%, 50% 60%, 70%, 80% of the cells are T_(CM/SCM/N) cells. In either case, the population of T cells includes both CD4+ cells and CD8+ cells (e.g., at least 20% of the CD3+ T cells are CD4+ and at least 3% of the CD3+ T cells are CD8+ and at least 70, 80 or 90% are either CD4+ or CD8+; at least 15%, 20%, 25%, 30%, 35%, 40%, 50%, 60% of the cells CD3+ cells are CD4+ and at least 4%, 5%, 8%, 10%, 20 of the CD3+ cells are CD8+ cells).

Also described is a method of treating cancer in a patient comprising administering a population of autologous or allogeneic human T cells (e.g., autologous or allogenic T cells comprising central memory T cells (T_(CM) cells) or a combination of central memory T cells, naïve T cells and stem central memory cells (i.e., the T cells are T_(CM/SCM/N) cells) at least 20%, 30%, 40%, 50% 60%, 70%, 80% of the cells are T_(CM/SCM/N) cells. In either case, the population of T cells includes both CD4+ cells and CD8+ cells (e.g., at least 20% of the CD3+ T cells are CD4+ and at least 3% of the CD3+ T cells are CD8+ and at least 70, 80 or 90% are either CD4+ or CD8+; at least 15%, 20%, 25%, 30%, 35%, 40%, 50%, 60% of the cells CD3+ cells are CD4+ and at least 4%, 5%, 8%, 10%, 20 of the CD3+ cells are CD8+ cells) transduced by a vector comprising an expression cassette encoding a chimeric antigen receptor, wherein chimeric antigen receptor comprises an amino acid sequence selected from SEQ ID NOs: 26-55 or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions). In various embodiments: the cancer is glioblastoma; and the transduced human T cells where prepared by a method comprising obtaining T cells from the patient, treating the T cells to isolate central memory T cells, and transducing at least a portion of the central memory cells to with a viral vector comprising an expression cassette encoding a chimeric antigen receptor, wherein chimeric antigen receptor comprises an amino acid sequence selected from SEQ ID NOs: 26-55 or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions).

Also described is: a nucleic acid molecule encoding an polypeptide comprising an amino acid sequence that is at least 95% identical to an amino acid sequence selected from SEQ ID NOs 26-55; a nucleic acid molecule encoding an polypeptide comprising an amino acid sequence that is identical to an amino acid sequence selected from SEQ ID NOs: 26-55 except for the presence of no more than 5 amino acid substitutions, deletions or insertions; a nucleic acid molecule encoding an polypeptide comprising an amino acid sequence that is identical to an amino acid sequence selected from SEQ ID NOs:26-55 except for the presence of no more than 5 amino acid substitutions; and a nucleic acid molecule encoding an polypeptide comprising an amino acid sequence that is identical to an amino acid sequence selected from SEQ ID NOs:26-55 except for the presence of no more than 2 amino acid substitutions.

T cells expressing a CAR comprising chlorotoxin or a variant thereof can be useful in treatment of cancers such as glioblastoma, as well as other cancers expressing a receptor for chlorotoxin, which include, but are not limited to: primary brain tumors and gliomas (glioblastoma multiforme WHO Grade IV, anaplastic astrocytoma WHO Grade III, low-grade astrocytoma WHO Grade II, pilocytic astrocytoma WHO Grade I, other ungraded gliomas, oligodendroglioma, gliosarcoma, ganglioglioma, meningioma, ependymona), neuroectodermal tumors (medulloblastoma, neuroblastoma, ganglioneuroma, melanoma (metastatic), melanoma (primary), pheochromocytoma, Ewing's sarcoma, primitive neuroectodermal tumors, small cell lung carcinoma, Schwannoma), other brain tumors (epidermoid cysts, brain tumors of unknown pathology, pituitary gland of glioblastoma multiforme pt., metastatic tumors to brain of unknown tissue origin), and other tumors (breast cancer, breast cancer metastases, kidney cancer, liver cancer lung cancer, lymphoma, ovarian cancer, pancreatic cancer, prostate cancer).

This disclosure also includes nucleic acid molecules that encode any of the CARs described herein (e.g., vectors that include a nucleic acid sequence encoding one of the CARs) and isolated T lymphocytes that express any of the CARs described herein.

The CAR described herein can include a spacer region located between the chlorotoxin domain (i.e., the chlorotoxin or variant thereof) and the transmembrane domain. A variety of different spacers can be used. Some of them include at least portion of a human Fc region, for example a hinge portion of a human Fc region or a CH3 domain or variants thereof. Table 1 below provides various spacers that can be used in the CARs described herein.

TABLE 1 Examples of Spacers Name Length Sequence a3 3 aa AAA linker 10 aa GGGSSGGGSG (SEQ ID NO: 2) IgG4 hinge (S→P) 12 aa ESKYGPPCPPCP (SEQ ID NO: 3) (S228P) IgG4 hinge 12 aa ESKYGPPCPSCP (SEQ ID NO: 4) IgG4 hinge (S228P) + linker 22 aa ESKYGPPCPPCPGGGSSGGGSG (SEQ ID NO: 5) CD28 hinge 39 aa IEVMYPPPYLDNEKSNGTIIHVKGKHL CPSPLFPGPSKP (SEQ ID NO: 6) CD8 hinge-48aa 48 aa AKPTTTPAPRPPTPAPTIASQPLSLRPE ACRPAAGGAVHTRGLDFACD (SEQ ID NO: 7) CD8 hinge-45 aa 45 aa TTTPAPRPPTPAPTIASQPLSLRPEACR PAAGGAVHTRGLDFACD (SEQ ID NO: 8) IgG4(HL-CH3) 129 aa ESKYGPPCPPCPGGGSSGGGSGGQPR (includes 5228P in hinge) EPQVYTLPPSQEEMTKNQVSLTCLVK GFYPSDIAVEWESNGQPENNYKTTPP VLDSDGSFFLYSRLTVDKSRWQEGNV FSCSVMHEALHNHYTQKSLSLSLGK (SEQ ID NO: 9) IgG4(L235E,N297Q) 229 aa ESKYGPPCPSCPAPEFEGGPSVFLFPP KPKDTLMISRTPEVTCVVVDVSQEDP EVQFNWYVDGVEVHQAKTKPREEQF QSTYRVVSVLTVLHQDWLNGKEYKC KVSNKGLPSSIEKTISKAKGQPREPQV YTLPPSQEEMTKNQVSLTCLVKGFYP SDIAVEWESNGQPENNYKTTPPVLDS DGSFFLYSRLTVDKSRWQEGNVFSCS VMHEALHNHYTQKSLSLSLGK (SEQ ID NO: 10) IgG4(5228P, L235E,N297Q) 229 aa ESKYGPPCPPCPAPEFEGGPSVFLFPP KPKDTLMISRTPEVTCVVVDVSQEDP EVQFNWYVDGVEVHQAKTKPREEQF QSTYRVVSVLTVLHQDWLNGKEYKC KVSNKGLPSSIEKTISKAKGQPREPQV YTLPPSQEEMTKNQVSLTCLVKGFYP SDIAVEWESNGQPENNYKTTPPVLDS DGSFFLYSRLTVDKSRWQEGNVFSCS VMHEALHNHYTQKSLSLSLGK (SEQ ID NO: 11) IgG4(CH3) 107 aa GQPREPQVYTLPPSQEEMTKNQVSLT CLVKGFYPSDIAVEWESNGQPENNYK TTPPVLDSDGSFFLYSRLTVDKSRWQ EGNVFSCSVMHEALHNHYTQKSLSLS LGK (SEQ ID NO: 12)

Some spacer regions include all or part of an immunoglobulin (e.g., IgG1, IgG2, IgG3, IgG4) hinge region, i.e., the sequence that falls between the CH1 and CH2 domains of an immunoglobulin, e.g., an IgG4 Fc hinge or a CD8 hinge. Some spacer regions include an immunoglobulin CH3 domain or both a CH3 domain and a CH2 domain. The immunoglobulin derived sequences can include one ore more amino acid modifications, for example, 1, 2, 3, 4 or 5 substitutions, e.g., substitutions that reduce off-target binding.

An “amino acid modification” refers to an amino acid substitution, insertion, and/or deletion in a protein or peptide sequence. An “amino acid substitution” or “substitution” refers to replacement of an amino acid at a particular position in a parent peptide or protein sequence with another amino acid. A substitution can be made to change an amino acid in the resulting protein in a non-conservative manner (i.e., by changing the codon from an amino acid belonging to a grouping of amino acids having a particular size or characteristic to an amino acid belonging to another grouping) or in a conservative manner (i.e., by changing the codon from an amino acid belonging to a grouping of amino acids having a particular size or characteristic to an amino acid belonging to the same grouping). Such a conservative change generally leads to less change in the structure and function of the resulting protein. The following are examples of various groupings of amino acids: 1) Amino acids with nonpolar R groups: Alanine, Valine, Leucine, Isoleucine, Proline, Phenylalanine, Tryptophan, Methionine; 2) Amino acids with uncharged polar R groups: Glycine, Serine, Threonine, Cysteine, Tyrosine, Asparagine, Glutamine; 3) Amino acids with charged polar R groups (negatively charged at pH 6.0): Aspartic acid, Glutamic acid; 4) Basic amino acids (positively charged at pH 6.0): Lysine, Arginine, Histidine (at pH 6.0). Another grouping may be those amino acids with phenyl groups: Phenylalanine, Tryptophan, and Tyrosine.

In certain embodiments, the spacer is derived from an IgG1, IgG2, IgG3, or IgG4 that includes one or more amino acid residues substituted with an amino acid residue different from that present in an unmodified spacer. The one or more substituted amino acid residues are selected from, but not limited to one or more amino acid residues at positions 220, 226, 228, 229, 230, 233, 234, 235, 234, 237, 238, 239, 243, 247, 267, 268, 280, 290, 292, 297, 298, 299, 300, 305, 309, 218, 326, 330, 331, 332, 333, 334, 336, 339, or a combination thereof. In this numbering scheme, described in greater detail below, the first amino acid in the IgG4(L235E,N297Q) spacer in Table 1 is 219 and the first amino acid in the IgG4(HL-CH3) spacer in Table 1 is 219 as is the first amino acid in the IgG hinge sequence and the IgG4 hinge linker (HL) sequence in Table 1

In some embodiments, the modified spacer is derived from an IgG1, IgG2, IgG3, or IgG4 that includes, but is not limited to, one or more of the following amino acid residue substitutions: C220S, C226S, S228P, C229S, P230S, E233P, V234A, L234V, L234F, L234A, L235A, L235E, G236A, G237A, P238S, S239D, F243L, P247I, S267E, H268Q, S280H, K290S, K290E, K290N, R292P, N297A, N297Q, S298A, S298G, S298D, S298V, T299A, Y300L, V305I, V309L, E318A, K326A, K326W, K326E, L328F, A330L, A330S, A331S, P331S, I332E, E333A, E333S, E333S, K334A, A339D, A339Q, P396L, or a combination thereof.

In certain embodiments, the modified spacer is derived from IgG4 region that includes one or more amino acid residues substituted with an amino acid residue different from that present in an unmodified region. The one or more substituted amino acid residues are selected from, but not limited to, one or more amino acid residues at positions 220, 226, 228, 229, 230, 233, 234, 235, 234, 237, 238, 239, 243, 247, 267, 268, 280, 290, 292, 297, 298, 299, 300, 305, 309, 218, 326, 330, 331, 332, 333, 334, 336, 339, or a combination thereof.

In some embodiments, the modified spacer is derived from an IgG4 region that includes, but is not limited to, one or more of the following amino acid residue substitutions: 220S, 226S, 228P, 229S, 230S, 233P, 234A, 234V, 234F, 234A, 235A, 235E, 236A, 237A, 238S, 239D, 243L, 247I, 267E, 268Q, 280H, 290S, 290E, 290N, 292P, 297A, 297Q, 298A, 298G, 298D, 298V, 299A, 300L, 305I, 309L, 318A, 326A, 326W, 326E, 328F, 330L, 330S, 331S, 331S, 332E, 333A, 333S, 333S, 334A, 339D, 339Q, 396L, or a combination thereof, wherein the amino acid in the unmodified spacer is substituted with the above identified amino acids at the indicated position.

For amino acid positions in immunoglobulin discussed herein, numbering is according to the EU index or EU numbering scheme (Kabat et al. 1991 Sequences of Proteins of Immunological Interest, 5th Ed., United States Public Health Service, National Institutes of Health, Bethesda, hereby entirely incorporated by reference). The EU index or EU index as in Kabat or EU numbering scheme refers to the numbering of the EU antibody (Edelman et al. 1969 Proc Natl Acad Sci USA 63:78-85).

A variety of transmembrane domains can be used in the. Table 2 includes examples of suitable transmembrane domains. Where a spacer domain is present, the transmembrane domain is located carboxy terminal to the spacer domain.

TABLE 2 Examples of Transmembrane Domains Name Accession Length Sequence CD3z J04132.1 21 aa LCYLLDGILFIYGVILTALFL  (SEQ ID NO: 13) CD28 NM_006139 27aa FWVLVVVGGVLACYSLLVTVAFIIF WV (SEQ ID NO: 14) CD28(M) NM_006139 28aa MFWVLVVVGGVLACYSLLVTVAFII FWV (SEQ ID NO: 15) CD4 M35160 22aa MALIVLGGVAGLLLFIGLGIFF  (SEQ ID NO: 16) CD8tm NM_001768 21aa IYIWAPLAGTCGVLLLSLVIT  (SEQ ID NO: 17) CD8tm2 NM_001768 23aa IYIWAPLAGTCGVLLLSLVITLY   (SEQ ID NO: 18) CD8tm3 NM_001768 24aa IYIWAPLAGTCGVLLLSLVITLYC  (SEQ ID NO: 19) 41BB NM_001561 27aa IISFFLALTSTALLFLLFF LTLR  FSVV (SEQ ID NO: 20)

Many of the CAR described herein include one or more (e.g., two) costimulatory domains. The costimulatory domain(s) are located between the transmembrane domain and the CD3ζ signaling domain. Table 3 includes examples of suitable costimulatory domains together with the sequence of the CD3ζ signaling domain.

TABLE 3 CD3ζ Domain and Examples of Costimulatory Domains Name Accession Length Sequence CD3ζ J04132.1 113 aa RVKFSRSADAPAYQQGQNQLYNELN LGRREEYDVLDKRRGRDPEMGGKPR RKNPQEGLYNELQKDKMAEAYSEIG MKGERRRGKGHDGLYQGLSTATKDT YDALHMQALPPR  (SEQ ID NO: 21) CD28 NM_006139 42 aa RSKRSRLLHSDYMNMTPRRPGPTRK HYQPYAPPRDFAAYRS  (SEQ ID NO: 22) CD28gg* NM_006139 42 aa RSKRSRGGHSDYMNMTPRRPGPTRK HYQPYAPPRDFAAYRS  (SEQ ID NO: 23) 41BB NM_001561 42 aa KRGRKKLLYIFKQPFMRPVQTTQEE DGCSCRFPEEEEGGCEL  (SEQ ID NO: 24) OX40 42 aa ALYLLRRDQRLPPDAHKPPGGGSFR TPIQEEQADAHSTLAKI  (SEQ ID NO: 25)

Among the CAR comprising chlorotoxin described herein are those summarized in Table 4 in which the spacer domain, transmembrane domain and costimulatory domain(s) for each CAR are indicated.

TABLE 4 Examples of CAR Comprising Chlorotoxin SEQ ID Costimulatory Name NO* FIG. Spacer TM Domain(s) CLTX-IgG4(EQ)- 26/41 7 IgG4(EQ) CD28 CD28 CD28tm-CD28-zeta CLTX-IgG4(HL-CH3)- 27/42 8 IgG4(HL-CH3) CD28 CD28 CD28tm-CD28-zeta CLTX-CD8h-CD28tm- 28/43 9 CD8h CD28 CD28 CD28-zeta CLTX-IgG4(hinge)- 29/44 10 IgG4(hinge) CD28 CD28 CD28tm-CD28-zeta CLTX-L-CD28tm-CD28- 30/45 11 L CD28 CD28 zeta CLTX-IgG4(EQ)- 31/46 12 IgG4(EQ) CD28 CD28-4-1BB CD28tm-CD28-4-1BB- zeta CLTX-IgG4(HL-CH3)- 32/47 13 IgG4(HL-CH3) CD28 CD28-4-1BB CD28tm-CD28-4-1BB- zeta CLTX-CD8h-CD28tm- 33/48 14 CD8h CD28 CD28-4-1BB CD28-4-1BB-zeta CLTX-IgG4(hinge)- 34/49 15 IgG4(hinge) CD28 CD28-4-1BB CD28tm-CD28-4-1BB- zeta CLTX-L-CD28tm-CD28- 35/50 16 L CD28 CD28-4-1BB 4-1BB-zeta CLTX-IgG4(EQ)- 36/51 17 IgG4(EQ) CD4 4-1BB CD4tm-4-1BB-zeta CLTX-IgG4(HL-CH3)- 37/52 18 IgG4(HL-CH3) CD4 4-1BB CD4tm-4-1BB-zeta CLTX-CD8h-CD28tm-4- 38/53 19 CD8h CD28 4-1BB 1BB-zeta CLTX-IgG4(hinge)- 39/54 20 IgG4(hinge) CD28 4-1BB CD28tm-4-1BB-zeta CLTX-L-CD28tm-4- 40/55 21 L CD28 4-1BB 1BB-zeta *SEQ ID NOs for sequence including signal sequence/SEQ ID NOs for sequence excluding signal sequence.

DESCRIPTION OF DRAWINGS

FIG. 1A-C: Generation of CLTX-CAR expressing T cells. (A) Schematic of the lentiviral construct encoding the chlorotoxin (CLTX)-redirected chimeric antigen receptor (CAR) cassette, where transcription of the CLTX-CAR, as well as the T2A ribosomal skip and truncated CD19 (CD19t) sequences are driven by the EF1 promoter (EF1p). (B) Diagram of the CLTX-CAR, which contains the extracellular 36-amino acid chlorotoxin peptide and IgG4Fc (EQ) spacer domains, the CD28 transmembrane domain, and the intracellular CD28 and CD3ζ cytoplasmic signaling domain sequences. (C) Flow cytometric analysis of healthy donor T cells (HD187.2 T_(CM/SCM/N)) engineered to express the CLTX-CAR. Shown is anti-CD19 anti-Fc and anti-CD8 staining, representing co-expression of the CLTX-CAR and CD19t transgenes in both CD8⁺ and CD4⁺ (CD8⁻) T cell subsets. Percentages of immunoreactive cells for transduced cells (CLTX-CAR) and untransduced cells (Mock) 18 days after CD3/CD28 bead stimulation are shown to demonstrate the capability to transduce human T cells with CLTX-CAR.

FIG. 2A-F: CLTX-CAR T cells specifically recognize glioblastoma cell line U251T. (A-E) CLTX binds to GBM cells and displays minimal binding to non-GBM cells. Shown is evaluation of chlorotoxin-conjugated Cy5.5 (CLTX-Cy5.5) binding to A, human peripheral blood mononuclear cells (PBMC) derived from a healthy donor; B, a human EBV-transformed lymphoblastic cell line, LCL; C, the large T antigen transformed human embryonic kidney line 293T; D, human astrocytes differentiated from healthy donor-derived induced pluripotent stem cells (iPSCs); and E, the human glioblastoma cell line U251T. Cell lines were cultured in media (untreated) or media containing 1 μM CLTX-Cy5.5 for 1 hr at 37° C. and then evaluated by flow cytometry. (F) Specific killing of glioma tumor line U251T by CLTX-CAR T cells, but not LCL, 293T or primary human astrocytes. Plotted are the numbers of viable target cells (LCL, 293T, astrocytes and U251T) co-cultured with CLTX-CAR T cells for 72 h, at an effector:target ratio=1:1 (15,000 T cells, 15,000 target cells), after normalizing to those co-cultured with Mock T cells for the same length of time. **: p<0.01; ns: non-specific, Student's t test performed between groups as indicated in the figure.

FIG. 3A-B: CLTX binding to multiple low-passage human primary brain tumor (PBT) lines is independent of IL13Rα2 expression. Flow cytometric analysis of (A) four IL13Rα2-low and (B) four IL13Rα2-high cell lines cultured in media containing 1 μM CLTX-Cy5.5 for 1 h, and then stained with PE-conjugated IL13Rα2 antibody.

FIG. 4A-B: CLTX-CAR T cell recognition and killing of low-passage PBT human glioblastoma lines is independent of IL13Rα2 expression. (A) CLTX-CAR T cells displays statistically significant killing of a panel of primary GBM lines versus the embryonic kidney line 293T. Plotted are the numbers of viable target cells cocultured with CLTX-CAR T cells for 24, 48 and 72 h, at an effector:target ratio=1:1 (15,000 T cells, 15,000 target cells), after normalizing to those cocultured with Mock T cells for the same length of time. ***:p<0.001, Student's t test performed between the PBT cell viability and 293T cell viability. (B) Elimination of PBT003-4 and PBT009 tumor cells by CLTX-CAR T cells, as compared to the Mock control, observed with live cell imaging. Representative images of PBT003-4 and PBT009 cells cocultured with mock or CLTX-CAR T cells, at an effector:target ratio=1:4 (4,000 T cells, 16,000 target cells), taken by brightfield microscopy immediately after the co-culture (0 h) and after 3 days of co-culture (72 h).

FIG. 5A-B: CLTX-CAR T cell activation after stimulating with GBM cells.

T cells were stimulated by target cells for 5 h at an effector:target ratio=1:1 (25,000 T cells, 25,000 target cells) in the presence of protein transport inhibitor. The percentage of CAR-T cells undergoing degranulation was determined using flow cytoimetry by CD107a immunoreactivity (A), and cytokine production detected by intracellular staining (B). **: p<0.01; ***: p<0.001, one-way ANOVA with Sidak-Bonferroni correction comparing the degranulation/cytokine secretion in each of the PBT-stimulated T cells with 293T cell-stimulated T cells.

FIG. 6A-C: Anti-tumor effect of CLTX-CAR T cells with different linker designs. (A) Schematic diagram of CLTX-CAR constructs differing in linkers, including IgG4Fc (EQ), IgG4(HL-CH3), CD8 h and short linker (L) (transmembrane domain not depicted). (B) CLTX-CAR T cells with different linkers are able to kill U251T GBM cells. Plotted are the numbers of viable U251T cells cocultured with T cells harboring different CLTX-redirected constructs for 24, 48 and 72 h, at an effector:target ratio=1:1 (15,000 T cells, 15,000 target cells), after normalizing to those cocultured with Mock T cells for the same length of time. (C) CLTX-CAR T cells with different linkers display differential cytokine production levels following antigen challenge. T cells engineered with different CLTX-redirected constructs were stimulated with U251T cells at an effector:target ratio=1:1 (20,000 T cells, 20,000 target cells). IFN-γ secretion was detected by ELISA assay of the supernatant. *: p<0.05; **: p<0.01; ***: p<0.001, one-way ANOVA analysis with Sidak-Bonferroni correction comparing the indicated CAR-T cells and mock T cells.

FIG. 7A-C: Anti-tumor effect of CLTX-CAR T cells with different intracellular signaling domains. (A) Schematic diagram of CLTX-CAR constructs differing in intracellular co-stimulatory domains CD28 and 41BB. (B) CLTX-CAR T cells with different co-stimulatory domains are able to kill U251T GBM cells. Plotted are the numbers of viable U251T cells cocultured with T cells harboring different CLTX-redirected constructs for 24, 48 and 72 h, at an effector:target ratio=1:1 (15,000 T cells, 15,000 target cells), after normalizing to those cocultured with Mock T cells for the same length of time. (C) CLTX-CAR T cells with different co-stimulatory domains produce various levels of cytokines following tumor challenge. T cells engineered with different CLTX-redirected constructs were stimulated with U251T cells at an effector:target ratio=1:1 (20,000 T cells, 20,000 target cells). IFN-γ secretion was detected by ELISA assay of the supernatant. **: p<0.01; ***:p<0.001, one-way ANOVA analysis with Sidak-Bonferroni correction comparing the indicated CAR-T cells and mock T cells.

FIG. 8A-B: CLTX-CAR T cells reduce growth of established U251T GBM tumors in vivo. (A) Schema showing the U251T xenograft growth and T cell treatment in NSG mice. Mice with subcutaneously engrafted U251T cells (day −14 to day 0) were treated with PBS (tumor only), Mock T cells, or CLTX-CAR T cells. (B) Tumor progression is inhibited by CLTX-CAR T cell treatment. Growth of tumor, determined through caliper measurement, over 20 days from the time of T cell injection (day 0 to day 20). ***:p<0.001, one-way ANOVA analysis with Sidak-Bonferroni correction performed for data at day 20 after T cell injection, comparing tumor volumes in CLTX-CAR treated mice with the tumor only or Mock-treated groups.

FIG. 9 depicts the amino acid sequence of CLTX-IgG4(L235E, N297Q)-CD28tm-CD28gg-zeta (SEQ ID NO:26).

FIG. 10 depicts the amino acid sequence of CLTX-IgG4(HL-CH3)-CD28tm-CD28gg-zeta (SEQ ID NO:27).

FIG. 11 depicts the amino acid sequence of CLTX-CD8 h-CD28tm-CD28gg-zeta (SEQ ID NO:28).

FIG. 12 depicts the amino acid sequence of CLTX-IgG4(hinge)-CD28tm-CD28gg-zeta (SEQ ID NO:29).

FIG. 13 depicts the amino acid sequence of CLTX-L-CD28tm-CD28gg-zeta (SEQ ID NO:30).

FIG. 14 depicts the amino acid sequence of CLTX-IgG4(L235E, N297Q)-CD28tm-CD28gg-4-1BB-zeta (SEQ ID NO:31).

FIG. 15 depicts the amino acid sequence of CLTX-IgG4(HL-CH3)-CD28tm-CD28gg-4-1BB-zeta (SEQ ID NO:32).

FIG. 16 depicts the amino acid sequence of CLTX-CD8 h-CD28tm-CD28gg-4-1BB-zeta (SEQ ID NO:33).

FIG. 17 depicts the amino acid sequence of CLTX-IgG4(hinge)-CD28tm-CD28gg-4-1BB-zeta (SEQ ID NO:34).

FIG. 18 depicts the amino acid sequence of CLTX-L-CD28tm-CD28gg-4-1BB-zeta (SEQ ID NO:35).

FIG. 19 depicts the amino acid sequence of CLTX-IgG4(L235E, N297Q)-CD28tm-4-1BB-zeta (SEQ ID NO:36).

FIG. 20 depicts the amino acid sequence of CLTX-IgG4(HL-CH3)-CD4tm-4-1BB-zeta (SEQ ID NO:37).

FIG. 21 depicts the amino acid sequence of CLTX-CD8 h-CD28tm-4-1BB-zeta (SEQ ID NO:38).

FIG. 22 depicts the amino acid sequence of CLTX-IgG4(hinge)-CD28tm-4-1BB-zeta (SEQ ID NO:39).

FIG. 23 depicts the amino acid sequence of CLTX-L-CD28tm-4-1BB-zeta (SEQ ID NO:40).

FIG. 24 depicts the CAR of FIG. 21 with a T2A (ribosomal skip sequence and a truncated CD19; SEQ ID NO:60). The truncated CD19 is co-expressed with CAR, permitting a simple way in which to identify and quantify transfected cells.

FIG. 25 depicts various chlorotoxin-related toxins (SEQ ID NOs:1, 61-70, 58, 57, 59, 71-73, and 56) and an alignment of their amino acid sequences (Dardevet et al. 2015 Toxins (Basel) 7:1079).

DETAILED DESCRIPTION

Described below is the structure, construction and characterization of various chimeric antigen receptors comprising chlorotoxin (CLTX). A chimeric antigen receptor (CAR) is a recombinant biomolecule that contains, at a minimum, an extracellular recognition domain, a transmembrane region, and an intracellular signaling domain. The term “antigen,” therefore, is not limited to molecules that bind antibodies, but to any molecule that can bind specifically to a target. For example, a CAR can include a ligand that specifically binds a cell surface receptor. The extracellular recognition domain (also referred to as the extracellular domain or simply by the recognition element which it contains) comprises a recognition element that specifically binds to a molecule present on the cell surface of a target cell. The transmembrane region anchors the CAR in the membrane. The intracellular signaling domain comprises the signaling domain from the zeta chain of the human CD3 complex and optionally comprises one or more costimulatory signaling domains. CARs can both to bind antigen and induce T cell activation, independent of MHC restriction. Thus, CARs are “universal” immunoreceptors which can treat a population of patients with antigen-positive tumors irrespective of their HLA genotype. Adoptive immunotherapy using T lymphocytes that express a tumor-specific CAR can be a powerful therapeutic strategy for the treatment of cancer.

One CAR comprising chlorotoxin described herein is referred to as CLTX-IgG4(EQ)-CD28gg-Zeta. This CAR includes a variety of important features including: chlorotoxin; an IgG4 Fc region that is mutated at two sites within the CH2 region (L235E; N297Q) in a manner that reduces binding by Fc receptors (FcRs); domain, a CD28 co-stimulatory domain, and CD3ζ activation domain.

In some cases the CAR described herein can be produced using a vector in which the CAR open reading frame is followed by a T2A ribosome skip sequence and a truncated CD19 (CD19t), which lacks the cytoplasmic signaling tail (truncated at amino acid 323). In this arrangement, co-expression of CD19t provides an inert, non-immunogenic surface marker that allows for accurate measurement of gene modified cells, and enables positive selection of gene-modified cells, as well as efficient cell tracking and/or imaging of the therapeutic T cells in vivo following adoptive transfer. Co-expression of CD19t provides a marker for immunological targeting of the transduced cells in vivo using clinically available antibodies and/or immunotoxin reagents to selectively delete the therapeutic cells, and thereby functioning as a suicide switch.

The CAR described herein can be produced by any means known in the art, though preferably it is produced using recombinant DNA techniques. Nucleic acids encoding the several regions of the chimeric receptor can be prepared and assembled into a complete coding sequence by standard techniques of molecular cloning known in the art (genomic library screening, PCR, primer-assisted ligation, site-directed mutagenesis, etc.) as is convenient. The resulting coding region is preferably inserted into an expression vector and used to transform a suitable expression host cell line, preferably a T lymphocyte cell line, and most preferably an autologous T lymphocyte cell line.

Various T cell subsets isolated from the patient, including unselected PBMC or enriched CD3 T cells or enriched CD3 or memory T cell subsets or T_(CM) or T_(CM/SCM/N) can be transduced with a vector for CAR expression. Central memory T cells are one useful T cell subset. Central memory T cell can be isolated from peripheral blood mononuclear cells (PBMC) by enriching for CD45RO+/CD62L+ cells, using, for example, the CliniMACS® device to immunomagnetically select cells expressing the desired receptors. The cells enriched for central memory T cells can be activated with anti-CD3/CD28, transduced with, for example, a SIN lentiviral vector that directs the expression of the CAR as well as a truncated human CD19 (CD19t), a non-immunogenic surface marker for both in vivo detection and potential ex vivo selection. The activated/genetically modified central memory T cells can be expanded in vitro with IL-2/IL-15 and then cryopreserved.

Example 1: Construction and Structure of CLTX-IgG4Fc(EQ)-CD28-zeta CAR

The structure of a useful CAR comprising chlorotoxin, CLTX-IgG4Fc(EQ)-CD28-zeta, is described below. The codon optimized CAR sequence includes: chlorotoxin, an IgG4 Fc spacer containing mutations (S228P, L235E) that greatly reduce Fc receptor-mediated recognition, a CD28 transmembrane domain, a costimulatory CD28 cytoplasmic signaling domain, and a CD3ζ cytoplasmic signaling domain. A T2A ribosome skip sequence separates this CAR sequence from CD19t, an inert, non-immunogenic cell surface detection/selection marker. This T2A linkage results in the coordinate expression of both the CAR and CD19t from a single transcript. FIG. 1A is a schematic drawing of the open reading frame of CLRX-IgG4Fc(EQ)-CD28-zeta-T2ACD19t. In this drawing, the CLTX-IgG4Fc(EQ)-CD28-zeta CAR, as well as the T2A ribosome skip and truncated CD19 sequences are all indicated. The expression of the CAR and CD19t cassette is driven by the human EF1 promoter (EF1p). FIG. 1B schematically depicts the expressed, mature CAR.

The CLTX-IgG4Fc(EQ)-CD28-zeta sequence was generated by fusion of the human GM-CSF receptor alpha leader peptide chlorotoxin, S228P/L235E/N297Q-modified IgG4 Fc hinge (where the double mutation L235E/N297Q interferes with FcR recognition), CD28 transmembrane, CD28 cytoplasmic signaling domain, and CD3ζ cytoplasmic signaling domain sequences. This sequence was synthesized de novo after codon optimization. The T2A sequence was obtained from digestion of a T2A-containing plasmid. The CD19t sequence was obtained from that spanning the leader peptide sequence to the transmembrane components (i.e., basepairs 1-972) of a CD19-containing plasmid. All three fragments, 1) CLTX-IgG4Fc(EQ)-CD28-zeta, 2) T2A, and 3) CD19t, were cloned into the multiple cloning site of the epHIV7 lentiviral vector. When transfected into appropriate cells, the vector integrates into the host cells genome. The amino acid sequence of CLTX-IgG4Fc(EQ)-CD28-zeta is presented in FIG. 9 with the various domains indicated.

Example 2: Construction and Structure of epHIV7 Used for Expression of CLTX-IgG4Fc(EQ)-CD28-zeta

The pHIV7 plasmid is the parent plasmid from which the clinical vector CLTX-IgG4Fc(EQ)-CD28-zeta-T2A-CD19t_epHIV7 was derived in the T cell Therapeutics Research Laboratory (TCTRL) at City of Hope (COH). The epHIV7 vector used for expression of the CAR was produced from pHIV7 vector. Importantly, this vector uses the human EF1 promoter to drive expression of the CAR. Both the 5′ and 3′ sequences of the vector were derived from pv653RSN as previously derived from the HXBc2 provirus. The polypurine tract DNA flap sequences (cPPT) were derived from HIV-1 strain pNL4-3 from the NIH AIDS Reagent Repository. The woodchuck post-transcriptional regulatory element (WPRE) sequence was previously described.

Construction of pHIV7 was carried out as follows. Briefly, pv653RSN, containing 653 bp from gag-pol plus 5′ and 3′ long-terminal repeats (LTRs) with an intervening SL3-neomycin phosphotransferase gene (Neo), was subcloned into pBluescript, as follows: In Step 1, the sequences from 5′ LTR to rev-responsive element (RRE) made p5′HIV-1 51, and then the 5′ LTR was modified by removing sequences upstream of the TATA box, and ligated first to a CMV enhancer and then to the SV40 origin of replication (p5′HIV-2). In Step 2, after cloning the 3′ LTR into pBluescript to make p3′HIV-1, a 400-bp deletion in the 3′ LTR enhancer/promoter was made to remove cis-regulatory elements in HIV U3 and form p3′HIV-2. In Step 3, fragments isolated from the p5′HIV-3 and p3′HIV-2 were ligated to make pHIV-3. In Step 4, the p3′HIV-2 was further modified by removing extra upstream HIV sequences to generate p3′HIV-3 and a 600-bp BamHI-SalI fragment containing WPRE was added to p3′HIV-3 to make the p3′HIV-4. In Step 5, the pHIV-3 RRE was reduced in size by PCR and ligated to a 5′ fragment from pHIV-3 (not shown) and to the p3′HIV-4, to make pHIV-6. In Step 6, a 190-bp BglII-BamHI fragment containing the cPPT DNA flap sequence from HIV-1 pNL4-3 (55) was amplified from pNL4-3 and placed between the RRE and the WPRE sequences in pHIV6 to make pHIV-7. This parent plasmid pHIV7-GFP (GFP, green fluorescent protein) was used to package the parent vector using a four-plasmid system.

A packaging signal, psi (ψ), is required for efficient packaging of viral genome into the vector. The RRE and WPRE enhance the RNA transcript transport and expression of the transgene. The flap sequence, in combination with WPRE, has been demonstrated to enhance the transduction efficiency of lentiviral vector in mammalian cells.

The helper functions, required for production of the viral vector), are divided into three separate plasmids to reduce the probability of generation of replication competent lentivirus via recombination: 1) pCgp encodes the gag/pol protein required for viral vector assembly; 2) pCMV-Rev2 encodes the Rev protein, which acts on the RRE sequence to assist in the transportation of the viral genome for efficient packaging; and 3) pCMV-G encodes the glycoprotein of the vesiculo-stomatitis virus (VSV), which is required for infectivity of the viral vector.

There is minimal DNA sequence homology between the pHIV7 encoded vector genome and the helper plasmids. The regions of homology include a packaging signal region of approximately 600 nucleotides, located in the gag/pol sequence of the pCgp helper plasmid; a CMV promoter sequence in all three helper plasmids; and a RRE sequence in the helper plasmid pCgp. It is highly improbable that replication competent recombinant virus could be generated due to the homology in these regions, as it would require multiple recombination events. Additionally, any resulting recombinants would be missing the functional LTR and tat sequences required for lentiviral replication.

The CMV promoter was replaced by the EF1α-HTLV promoter (EF1p), and the new plasmid was named epHIV7. The EF1p has 563 bp and was introduced into epHIV7 using NruI and NheI, after the CMV promoter was excised.

The lentiviral genome, excluding gag/pol and rev that are necessary for the pathogenicity of the wild-type virus and are required for productive infection of target cells, has been removed from this system. In addition, the CLTX-IgG4Fc(EQ)-CD28-zeta-T2ACD19t_epHIV7 vector construct does not contain an intact 3′LTR promoter, so the resulting expressed and reverse transcribed DNA proviral genome in targeted cells will have inactive LTRs. As a result of this design, no HIV-I derived sequences will be transcribed from the provirus and only the therapeutic sequences will be expressed from their respective promoters. The removal of the LTR promoter activity in the SIN vector is expected to significantly reduce the possibility of unintentional activation of host genes.

Example 3: Production of Vectors for Transduction of Patient T Cells

Vectors for transduction of patient T cells can be prepared as follows. For each plasmid (i.e., 1) the plasmid expressing the CAR and, optionally, a marker such as truncated CD19; 2) pCgp; 3) pCMV-G; and 4) pCMV-Rev2), a seed bank is generated, which is used to inoculate the fermenter to produce sufficient quantities of plasmid DNA. The plasmid DNA is tested for identity, sterility and endotoxin prior to its use in producing lentiviral vector.

Briefly, cells are expanded from the 293T working cell (WCB), which has been tested to confirm sterility and the absence of viral contamination. A vial of 293T cells from the 293T WCB is thawed. Cells are grown and expanded until sufficient numbers of cells exists to plate an appropriate number of 10 layer cell factories (CFs) for vector production and cell train maintenance. A single train of cells can be used for production.

The lentiviral vector is produced in sub-batches of up to 10 CFs. Two sub-batches can be produced in the same week leading to the production of approximately 20 L of lentiviral supernatant/week. The material produced from all sub-batches is pooled during the downstream processing phase, in order to produce one lot of product. 293T cells are plated in CFs in 293T medium (DMEM with 10% FBS). Factories are placed in a 37° C. incubator and horizontally leveled in order to get an even distribution of the cells on all the layers of the CF. Two days later, cells are transfected with the four lentiviral plasmids described above using the CaPO₄ method, which involves a mixture of Tris:EDTA, 2M CaCl₂, 2×HBS, and the four DNA plasmids. Day 3 after transfection, the supernatant containing secreted lentiviral vectors is collected, purified and concentrated. After the supernatant is removed from the CFs, End-of-Production Cells are collected from each CF. Cells are trypsinized from each factory and collected by centrifugation. Cells are resuspended in freezing medium and cryopreserved. These cells are later used for replication-competent lentivirus (RCL) testing.

To purify and formulate vectors crude, supernatant is clarified by membrane filtration to remove the cell debris. The host cell DNA and residual plasmid DNA are degraded by endonuclease digestion (Benzonase®). The viral supernatant is clarified of cellular debris using a 0.45 μm filter. The clarified supernatant is collected into a pre-weighed container into which the Benzonase® is added (final concentration 50 U/mL). The endonuclease digestion for residual plasmid DNA and host genomic DNA is performed at 37° C. for 6 h. The initial tangential flow ultrafiltration (TFF) concentration of the endonuclease-treated supernatant is used to remove residual low molecular weight components from the crude supernatant, while concentrating the virus ˜20 fold. The clarified endonuclease-treated viral supernatant is circulated through a hollow fiber cartridge with a NMWCO of 500 kD at a flow rate designed to maintain the shear rate at ˜4,000 sec⁻¹ or less, while maximizing the flux rate. Diafiltration of the nuclease-treated supernatant is initiated during the concentration process to sustain the cartridge performance. An 80% permeate replacement rate is established, using 4% lactose in PBS as the diafiltration buffer. The viral supernatant is brought to the target volume, representing a 20-fold concentration of the crude supernatant, and the diafiltration is continued for 4 additional exchange volumes, with the permeate replacement rate at 100%.

Further concentration of the viral product is accomplished by using a high speed centrifugation technique. Each sub-batch of the lentivirus is pelleted using a Sorvall RC-26 plus centrifuge at 6000 RPM (6,088 RCF) at 6° C. for 16-20 h. The viral pellet from each sub-batch is then reconstituted in a 50 mL volume with 4% lactose in PBS. The reconstituted pellet in this buffer represents the final formulation for the virus preparation. The entire vector concentration process results in a 200-fold volume reduction, approximately. Following the completion of all of the sub-batches, the material is then placed at −80° C., while samples from each sub-batch are tested for sterility. Following confirmation of sample sterility, the sub-batches are rapidly thawed at 37° C. with frequent agitation. The material is then pooled and manually aliquoted in the Class II Type A/B3 biosafety cabinet. A fill configuration of 1 mL of the concentrated lentivirus in sterile USP class 6, externally threaded O-ring cryovials is used.

To ensure the purity of the lentiviral vector preparation, it is tested for residual host DNA contaminants, and the transfer of residual host and plasmid DNA. Among other tests, vector identity is evaluated by RT-PCR to ensure that the correct vector is present.

Example 4: Preparation of T Cells Suitable for Use in ACT

If T_(CM) are to be used to express the CAR, suitable patient cells can be prepared as follows. First, T lymphocytes are obtained from a patient by leukopheresis, and the appropriate allogenic or autologous T cell subset, for example, Central Memory T cells (T_(CM)), are genetically altered to express the CAR, then administered back to the patient by any clinically acceptable means, to achieve anti-cancer therapy.

Suitable T_(CM) can be generated as follow. Apheresis products obtained from consented research participants are ficolled, washed and incubated overnight. Cells are then depleted of monocyte, regulatory T cell and naïve T cell populations using GMP grade anti-CD14, anti-CD25 and anti-CD45RA reagents (Miltenyi Biotec) and the CliniMACS™ separation device. Following depletion, negative fraction cells are enriched for CD62L+T_(CM) cells using DREG56-biotin (COH clinical grade) and anti-biotin microbeads (Miltenyi Biotec) on the CliniMACS™ separation device.

Following enrichment, T_(CM) cells are formulated in complete X-Vivo15 plus 50 IU/mL IL-2 and 0.5 ng/mL IL-15 and transferred to a Teflon cell culture bag, where they are stimulated with Dynal ClinEx™ Vivo CD3/CD28 beads. Up to five days after stimulation, cells are transduced with lentiviral vector expressing the desired CAR at a multiplicity of infection (MOI) of 1.0 to 0.3. Cultures are maintained for up to 42 days with addition of complete X-Vivo15 and IL-2 and IL-15 cytokine as required for cell expansion (keeping cell density between 3×10⁵ and 2×10⁶ viable cells/mL, and cytokine supplementation every Monday, Wednesday and Friday of culture). Cells typically expand to approximately 10⁹ cells under these conditions within 21 days. At the end of the culture period cells are harvested, washed twice and formulated in clinical grade cryopreservation medium (Cryostore CS5, BioLife Solutions).

On the day(s) of T cell infusion, the cryopreserved and released product is thawed, washed and formulated for re-infusion. The cryopreserved vials containing the released cell product are removed from liquid nitrogen storage, thawed, cooled and washed with a PBS/2% human serum albumin (HSA) Wash Buffer. After centrifugation, the supernatant is removed and the cells resuspended in a Preservative-Free Normal Saline (PFNS)/2% HSA infusion diluent. Samples are removed for quality control testing.

Example 5: Expression of Cltx-IgG4(EQ)-CD28gg-Zeta

FIG. 1C depicts the results of Flow cytometric analysis of healthy donor T cells (HD187.2 T_(CM/SCM/N)) engineered to express the CLTX-CAR. Shown is anti-CD19 anti-Fc and anti-CD8 staining, representing co-expression of the CLTX-CAR and CD19t transgenes in both CD8⁺ and CD4⁺ (CD8⁻) T cell subsets. Percentages of immunoreactive cells for transduced cells (CLTX-CAR) and untransduced cells (Mock) 18 days after CD3/CD28 bead stimulation are shown to demonstrate the capability to transduce human T cells with CLTX-CAR.

Example 6: Chlorotoxin and Cltx-IgG4(EQ)-CD28gg-Zeta T Cells Specifically Recognize Glioma Cell Line U251

Chlorotoxin conjugated to the fluorescent label, Cy5.5 (CLTX-Cy5.5) was used to assess chlorotoxin binding to various cell types. The results of this study are presented in FIGS. 2A-E (A, human peripheral blood mononuclear cells (PBMC) derived from a healthy donor; B, a human EBV-transformed lymphoblastic cell line, LCL; C, the large T antigen transformed human embryonic kidney line 293T; D, human astrocytes differentiated from healthy donor-derived induced pluripotent stem cells (iPSCs); and E, the human glioblastoma cell line U251T). Cell lines were cultured in media (untreated) or media containing 1 μM CLTX-Cy5.5 for 1 hr at 37° C. and then evaluated by flow cytometry.

As shown in FIG. 2F, the CLTX-CAR T cells specifically kill glioma tumor line U251T, but not LCL, 293T or primary human astrocytes. Plotted are the numbers of viable target cells (LCL, 293T, astrocytes and U251T) co-cultured with CLTX-CAR T cells for 72 h, at an effector:target ratio=1:1 (15,000 T cells, 15,000 target cells), after normalizing to those co-cultured with Mock T cells for the same length of time.

Example 7: Chlorotoxin Binds to Low-Passage PBT Human Glioblastoma Lines Independent of IL13Rα2 Expression

To examine whether chlorotoxin binding is independent of IL13Rα2 expression, flow cytometric analysis of IL13RA2-low cell lines and IL13RA2-high cell lines were cultured in the media containing 1 uM of CLTX-Cy5.5 for 1 h, and then stained with PE-conjugated IL13Rα2 antibody was carried out. As can be seen in FIG. 3A-B, chlorotoxin binds to low-passage PBT human glioblastoma lines independent of IL13Rα2 expression.

Example 8: CLTX-IgG4(EQ)-CD28gg-Zeta T Cells Recognize and Kill Low-Passage PBT Human Glioblastoma Lines Independent of IL13Rα2 Expression and TCGA Molecular Subtype

As shown in FIG. 4A, CLTX-CAR T cells displays statistically significant killing of a panel of primary GBM lines versus the embryonic kidney line 293T. Plotted are the numbers of viable target cells cocultured with CLTX-CAR T cells for 24, 48 and 72 h, at an effector:target ratio=1:1 (15,000 T cells, 15,000 target cells), after normalizing to those cocultured with Mock T cells for the same length of time.

FIG. 4B shows the elimination of PBT003-4 and PBT009 tumor cells by CLTX the CLTX-CAR T cells can -CAR T cells, as compared to the Mock control, observed with live cell imaging. Representative images of PBT003-4 and PBT009 cells cocultured with mock or CLTX-CAR T cells, at an effector:target ratio=1:4 (4,000 T cells, 16,000 target cells), taken by brightfield microscopy immediately after the co-culture (0 h) and after 3 days of co-culture (72 h).

Example 9: CLTX-IgG4(EQ)-CD28gg-Zeta T Cells are Activated by Stimulation with GBM Cells

T cells (mock or expressing CLTX CAR) were stimulated by target cells for 5 h at an effector:target ratio=1:1 (25,000 T cells, 25,000 target cells) in the presence of protein transport inhibitor. The percentage of CAR-T cells undergoing degranulation was determined using flow cytometry by CD107a immunoreactivity (FIG. 5A), and cytokine production detected by intracellular staining (FIG. 5B).

Example 10: CLTX-CAR T Cells with Different Spacer Designs are Effective Against Tumor Cells

FIG. 6A is a schematic diagram of CLTX-CAR constructs having different spacers (linkers), including IgG4Fc (EQ), IgG4(HL-CH3), CD8 h and short linker (L). All have the CD28 transmembrane domain (not depicted). As shown in FIG. 6B, CLTX-CAR T cells with different linkers are able to kill U251T GBM cells. Plotted are the numbers of viable U251T cells cocultured with T cells harboring different CLTX-redirected constructs for 24, 48 and 72 h, at an effector:target ratio=1:1 (15,000 T cells, 15,000 target cells), after normalizing to those cocultured with Mock T cells for the same length of time. As shown in FIG. 6C, CLTX-CAR T cells with different linkers display differential cytokine production levels following antigen challenge. T cells engineered with different CLTX-redirected constructs were stimulated with U251T cells at an effector:target ratio=1:1 (20,000 T cells, 20,000 target cells). IFN-γ secretion was detected by ELISA assay of the supernatant.

Example 11: Anti-Tumor Effect of CLTX-CAR T Cells with Different Intracellular Signaling Domains

FIG. 7A is a schematic diagram of CLTX-CAR constructs having different intracellular co-stimulatory domains CD28 and 41BB. As shown in FIG. 7B, CLTX-CAR T cells with different co-stimulatory domains are able to kill U251T GBM cells. Plotted are the numbers of viable U251T cells cocultured with T cells harboring different CLTX-redirected constructs for 24, 48 and 72 h, at an effector:target ratio=1:1 (15,000 T cells, 15,000 target cells), after normalizing to those cocultured with Mock T cells for the same length of time. As shown in FIG. 7C, CLTX-CAR T cells with different co-stimulatory domains produce various levels of cytokines following tumor challenge. T cells engineered with different CLTX-redirected constructs were stimulated with U251T cells at an effector:target ratio=1:1 (20,000 T cells, 20,000 target cells). IFN-γ secretion was detected by ELISA assay of the supernatant.

Example 12: CLTX-CAR T Cells Reduce Growth of Established U251T GBM Tumors In Vivo

FIG. 8A is a schematic depiction of a study of U251T xenograft growth and T cell treatment in NSG mice. Mice with subcutaneously engrafted U251T cells (day −14 to day 0) were treated with PBS (tumor only), Mock T cells, or CLTX-CAR T cells. FIG. 8B, tumor progression is inhibited by CLTX-CAR T cell treatment. Growth of tumor, determined through caliper measurement, over 20 days from the time of T cell injection (day 0 to day 20).

Example 13: Additional CLTX CAR

FIGS. 9-24 present the amino acid sequences of various additional CLTX-CAR that can be constructed and expressed as described above for the CLTX-IgG4(EQ)-CD28gg-Zeta CAR. In FIGS. 8-24 the various regions (listed below the sequence in each figure from amino to carboxy terminus are indicated by alternating underlined portions and not underlined portions. Thus, in FIG. 9 the GMCSFRa signal peptide is underlined, the chlorotoxin sequence is not underlined, the spacer (IgG4(SmP)(L235E,N297Q)) is underlined, the CD28 transmembrane sequence is not underlined, the CD28cyto (LLmGG) co-stimulatory domain is underlined, the (Gly)3 sequence separating the co-stimulatory domain from the CD3 zeta sequence is not underlined, and the CD3 zeta sequence is underlined. In FIGS. 9-23 the T2A and CD19t sequences co-expressed with the CAR are not shown. FIG. 24 depicts the CAR of FIG. 23 with a T2A (ribosomal skip sequence and a truncated CD19 included. The truncated CD19 is co-expressed with CAR, permitting a simple way in which to identify and quantify transfected cells.

Example 14: Additional Toxin Sequences

FIG. 25 depicts a sequence alignment of chlorotoxin with various chlorotoxin related toxins (Dardevet et al. 2015 Toxins (Basel) 7:1079). These toxins can, in some cases be substituted for chlorotoxin in the CAR described herein. 

1.-32. (canceled)
 33. A method for treating a malignant glioma comprising administering a therapeutically effective dose of T cells expressing a chimeric antigen receptor, wherein the chimeric antigen receptor comprises: chlorotoxin; a spacer domain, a transmembrane domain selected from: a CD4 transmembrane domain, a CD8 transmembrane domain, a CD28 transmembrane domain, and a CD3ζ transmembrane domain; a costimulatory domain; and CD3 ζ signaling domain.
 34. The method of claim 33, wherein the chlorotoxin comprises the amino acid sequence of SEQ ID NO:
 1. 35. The method of claim 33, wherein the spacer region comprises 5-300 amino acids.
 36. The method of claim 33, wherein the spacer region comprises an amino acid sequence selected from the group consisting of SEQ ID NOs: 2-12.
 37. The method of claim 33, wherein the spacer comprises an IgG hinge region.
 38. The method of claim 33, wherein the chimeric antigen receptor comprising an amino acid sequence: selected from the group consisting of: an amino acid sequence that is identical to SEQ ID NO: 26 or differs from SEQ ID NO: 26 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 27 or differs from SEQ ID NO: 27 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 28 or differs from SEQ ID NO: 28 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 29 or differs from SEQ ID NO: 29 no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 30 or differs from SEQ ID NO: 30 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 31 or differs from SEQ ID NO: 31 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 32 or differs from SEQ ID NO: 32 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 33 or differs from SEQ ID NO: 33 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 34 or differs from SEQ ID NO: 34 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 35 or differs from SEQ ID NO: 35 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 36 or differs from SEQ ID NO: 36 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 37 or differs from SEQ ID NO: 37 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 38 or differs from SEQ ID NO: 38 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 39 or differs from SEQ ID NO: 39 by no more than 5 single amino acid substitutions; and an amino acid sequence that is identical to SEQ ID NO: 40 or differs from SEQ ID NO: 41 by no more than 5 single amino acid substitutions.
 39. The method of claim 33, wherein the chimeric antigen receptor consists of an amino acid sequence: selected from the group consisting of: an amino acid sequence that is identical to SEQ ID NO: 26 or differs from SEQ ID NO: 26 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 27 or differs from SEQ ID NO: 27 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 28 or differs from SEQ ID NO: 28 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 29 or differs from SEQ ID NO: 29 no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 30 or differs from SEQ ID NO: 30 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 31 or differs from SEQ ID NO: 31 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 32 or differs from SEQ ID NO: 32 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 33 or differs from SEQ ID NO: 33 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 34 or differs from SEQ ID NO: 34 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 35 or differs from SEQ ID NO: 35 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 36 or differs from SEQ ID NO: 36 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 37 or differs from SEQ ID NO: 37 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 38 or differs from SEQ ID NO: 38 by no more than 5 single amino acid substitutions; an amino acid sequence that is identical to SEQ ID NO: 39 or differs from SEQ ID NO: 39 by no more than 5 single amino acid substitutions; and an amino acid sequence that is identical to SEQ ID NO: 40 or differs from SEQ ID NO: 41 by no more than 5 single amino acid substitutions.
 40. The method of claim 33, wherein the chimeric antigen receptor comprises an amino acid sequence selected from SEQ ID NOs: 26-55.
 41. The method of claim 33, wherein the chimeric antigen receptor consists of an amino acid sequence selected from SEQ ID NOs: 26-55.
 42. The method of claim 33, wherein the malignant glioma is anaplastic astrocytoma.
 43. The method of claim 33, wherein the malignant glioma is glioblastoma.
 44. The method of claim 33, wherein the malignant glioma has reoccurred subsequent to a prior treatment for malignant glioma. 